i bc27f85be50b71b1 (280 page)

Table VU-1. Continued

Type

Description

Hemipelvectomy

Also indicated in cases of malignancy. A muscle flap cov

(half of the

ers the internal organs.

pelvis is

removed along

with the enrire

lower limb)

·Unless otherwise stated, the etiology of these amputations is from peripheral vascular

disease.

Sources: Data from A Thompson, A Skinner, J Piercy (cds), Tidy's Physiotherapy (12th

cd). Oxford, UK: Butterworth-Heinemann, 1992;260; B Engstrom, C Van de Ven (cds).

Therapy for Amputees (3rd cd), Edinburgh, UK: Churchill Livingsrone, 1999;208, 187-

188, 149-150; B May (ed). Amputations and Prosthetics: A Case Study Approach. Phil·

adelphia: FA Davis, 1 996;62-63; G Sanders (cd). Lower limb Amputations: A Guide to

Rehabilitarion. Philadelphia: FA Davis, 1986;101-102; M Lusardi, C Nielsen (cds),

Orthotics and Prosthetics in Rehabilitation. Bosron: Butterworth-Heinemann, 2000;

370-373; and JE Edelstein. Prosthetic Assessment and Management. In SB O'Sullivan,

TJ Schmin (eds), Physical Rehabilitation; Assessment and Treatment (4th ed). Philadel·

phia: FA Davis, 200 1 ;645-673.

Table VU-2. Types of Upper-Extremity Amputations·

Type

Description

Transmetacarpal

Only the affected regions are removed; remaining

digits are preserved ro spare as much function

as possible. With amputations of the fifth

metacarpal, hand function is seriously compromised, especially for tasks such as grasping.

Wrist disarticulation

Distal radial ulnar joint funnion is often retained

to maintain rotation of the radius.

Transradial

Oprimum residual limb length for eventual

prosthetic firring is 8 em above the ulnar styloid.

Active prosthetic devices are operated by elbow

extension and shoulder flexion, shoulder girdle

protraction, or both.

Elbow disarticulation

Nor a choice location for amputation secondary to

the poor cosmetic look created and decreased

postsurgical function of the prosthesis.

API't:.NDIX VII; AMPlITATION

893

Type

Description

Transhumeral

Often performed as ::l result of primary m::llig-

nancy or metastatic disease. Optimum residual

limb length for eventual prosthetic fitting is 10

cm above the elbow JOIOt.

Shoulder disarticulation

Often performed 3S a result of primary maligancy

or metastatic disease. The head of humerus is

maintained, or the acromion process and

clavicle are trimmed to create a rounded

appearance.

Forequarter

Often performed as a result of primary malignancy

or metastatic disease. Consists of removal of the

patient's clavicle, scapula, ::lnd arm.

·Unless Othcrwl�e Slated, the etiology of these amputations IS from trauma.

Sources: Data from B Engstrom. C Van de Ven (eds). Therapy for Amputees (3rd ed).

Edinburgh, UK: Churchill Livingstone, 1999;243-257; M Lusardi, C Nielsen (eds).

OrthOtiCS and Prosthetics in Rehabilitation. Boston: Butterworth-Heinemann,

2000;573; SN Baneqee (cd). Rehabilitation Management of Ampurees. Baltimore: Wilhams & Wilkll1�. 1982;30-33; and R Ham, L Cotton (eds). Limb AmpUiation: From Aeuology to Rehahlln;nion. london: Chapman & Hall, 1991;136-143.

Table VIJ-3. General PhYSIcal Therapy Considerations and

Treaunem Suggestions

ConsideC:1rions

Tre::ltment Suggestions

Psychological

Patients who undergo an amputation, especially of the

impact of

upper extremiry, often experience psychological changes

ampmatlon

during the acute stage of their care. Patients may experience grief, anger, denial, and sadness. It is Important (Q

establish a rapport with the patient based on trust and

respect. To help the patient regain his or her self-esteem,

encourage him or her to take an active role in the therapy session, and highlight successes in therapy. The

physical therapist should request a psychiatric or social

service consult if the patient'S psychosocial issues are

Interfering with physical therapy intervention.

Residual hmb

Physical therapy techniques may involve the use of ace

edema

wraps, shrinker socks, rigid dressings (lower extremity),

or a combination of these according [Q the pacient's

needs along With the physician's or facility'S protocols.

894 AClITE CARE HANDBOOK FOR PHYSICAL 11-IER/WISTS

Table VII-3. Comj,wed

Considerations

Treatment Suggestions

Safe residual limb wrapping involves the use of a figure

eight or angular pattern, anchoring turns around the

most proximal joint, increased distal pressure, and a

smomh or wrinkle-free application.

The physical therapist should elevate the residual limb in a

position that prevents joint contracture formation.